Case of the Week 10-14-13: Running Out of Breath

I saw a good friend of mine last week who is a triathlete and recently opened a dog running business this summer. He had to stop running in the past month and has difficulty training due to thoracic pain and difficulty breathing while running.

History in a nutshell:

early 30s male with c/o moderate and intermittent right mid thoracic pain

Sx worse with thoracic rotation right, deep breath, coughing

unable to run his normal 7 minute mile pace due to fatigue and trouble breathing - always feels out of breath too early in the run

This improved his thoracic rotation to the right to DN, mild loss, an improvement from severe loss, DP. Apical expansion was still limited, so I instructed him on the hooklying balloon breathing with right UE in flexion. I manually held his left ribcage in depression after the first exhale to facilitate right rib expansion during inhalation. This was very difficult for him during the initial 3-4 repetitions. However, after 3 more repetitions of 4 deep breaths, right rib expansion improved significantly.

Thoracic rotation to the right was still DN compared to left, but improved over prior to the breathing exercise/manual correction.

I have blogged about this patient before, for various ankle, knee, and posterior tibialis issues

after changing his running form to a mid foot strike, working on his symmetry and increasing his cadence, he was able to go from 5ks to marathons within 6 months

the entire last year, he only came for a few maintenance visits here and there, but was largely pain free - a difference of regular visits every 2-3 months for 4-6 visits to work on nagging issues

this year, starting the dog running business, he mostly holds the dogs on the right and is either being pulled into thoracic rotation left, or actively limited that by preventing trunk rotation

he does try to switch leash holding sides, but apparently is not doing it enough, thus limiting his thoracic rotation left

the active holding and bracing eventually limited his rib expansion, this limiting difficulty breathing during running

a facebook follow up told me that he is rotating better, but is still having pain because he has to run dogs daily, so this is something we will be working on in terms of rotation, trunk mobility, etc... - any thoughts or ideas?

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